- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,129.19 / $9,062.00 / $18,276.00
| Facility | | $1,129.19 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $780.00 / $3,734.03 / $9,895.33
| Facility | | $780.00 | $3,734.03 | $9,895.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.64 / $1,298.57 / $1,949.56
| Facility | | $860.64 | $1,298.57 | $1,949.56 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $221.35 / $274.60 / $310.60
| Facility | 80 | $221.35 | $274.60 | $310.60 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $152.63 / $192.22 / $217.42
| Facility | AS | $152.63 | $192.22 | $217.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $461.00 / $3,866.00 / $6,584.00
| Facility | | $461.00 | $3,866.00 | $6,584.00 |